Xanthogranulomatous pyelonephritis presenting as a type IV renal cyst.

A 20-year-old woman presented to our outpatient clinic with a 5-week history of recurrent right lumbar back pain. Contrast-enhanced computed tomography scan showed a Bosniak class IV renal cyst. She was treated with radical nephrectomy. Histopathology revealed xanthogranulomatous pyelonephritis.

Tubulocystic Renal Cell Carcinoma: A Great Imitator.

Tubulocystic renal cell carcinoma (TCRC) is a rare renal tumor. Patients are usually asymptomatic; it is usually detected incidentally, during imaging studies for Bosniak type III and type IV renal cysts. These tumors rarely metastasize. The role of targeted therapy in such rare tumors is still controversial. We report a case of TCRC initially presented as a Bosniak type II renal cyst and was discovered ultimately to be a metastatic disease. This type of presentation might broaden our understanding of this rare disease.

Comparison of sonoelastography with sonourethrography and retrograde urethrography in the evaluation of male anterior urethral strictures.

OBJECTIVE: Retrograde urethrography (RUG) is the most common and preferred imaging modality for imaging of the anterior urethral strictures despite its well-known limitations and disadvantages. Sonourethrography (SUG) was introduced in 1988 to overcome the limitations of RUG and to provide more accurate results. As proper selection of imaging modality is very important for planning the treatment, various advances in this area are required. One of the major factors for recurrence of stricture disease is spongiofibrosis. Sonoelastography (SE) is a newer technique, tried in various other pathologies. In this study, we have used this technique for the first time to assess its efficacy in the evaluation of anterior urethral stricture disease by comparison with RUG and SUG. MATERIAL AND METHODS: Between August 2014 and May 2015, 77 patients with clinical features of anterior urethral stricture disease were included in the study and evaluated by RUG followed by SUG and SE for stricture location, length, depth of spongiofibrosis and periurethral pathologies. The results were then correlated with operative and histopathological findings. RESULTS: Overall diagnostic accuracy of SE, SUG, and RGU for the estimation of stricture location, and length were estimated 92.68% vs. 91.54%, 79% vs. 78.87% and 80.48% vs. 43.66%, respectively, while for depth of spongiofibrosis SE, and SUG had accuracy rates of 87.3%, 48%, respectively. The mean length measured on SE was nearest to the mean intra-operative stricture length (21.34+11.8 mm). SE findings significantly correlated with the colour of bladder mucosa on cystoscopic examination (p=0.003) whereas the association was non-significant (p=0.127) for difficulty in incision. While a nonsignificant correlation existed between SUG findings related both to the colour of the bladder mucosa and difficulty in incision on cystoscopy, SE findings had a significant association (p<0.001) with histopathology findings for severe degree of fibrosis. CONCLUSION: Sonoelastography estimates stricture site and length better in comparison with RUG and SUG. It estimates degree of spongiofibrosis which serves as an important prognostic factor for stricture recurrence more accurately than SUG.

'Real-time sonoelastography' in anterior urethral strictures: A novel technique for assessment of spongiofibrosis.

INTRODUCTION: Spongiofibrosis assessment is critically important in the evaluation of anterior urethral strictures as its severity is directly proportional to stricture recurrence and thus affects management. Retrograde urethrography (RGU) is ineffective in the evaluation of spongiofibrosis. Sonourethrography (SUG) delineates it but does not accurately estimate its depth. Real-time elastography (RTE), a newer technique that not only attempts a qualitative but also quantitative estimation of spongiofibrosis (tissue stiffness) which results due to underlying pathological processes. MATERIAL AND METHODS: In the present study, various elastographic patterns and strain ratios in anterior urethral stricture patients were studied and compared to operative and histopathological findings. Sixty-three RGU diagnosed anterior urethral stricture cases were taken and re-evaluated by SUG and SE by another radiologist who was blinded to the findings of the RGU. Strain patterns and ratios of spongiofibrotic segments were documented and compared with operative findings as gold standard. RESULTS: Blue pattern on RTE showed 100% concordance with severe fibrosis as evaluated against histopathological findings whereas green pattern showed 87.5% concordance with moderate degree of fibrosis. Severe degree of fibrosis cases, confirmed on histopathology had a significantly higher mean strain ratio (10.51 ±2.297) as compared to moderate degree (6.33 ±2.353) (p <0.001 S). CONCLUSIONS: Real time sonoelastography in the evaluation of spongiofibrosis not only assesses it qualitatively but also quantifies it. Strain ratios are statistically better indicators for estimating spongiofibrosis.

A rare case of lateral ovotesticular disorder with Klinefelter syndrome mosaicism 46, XX/47, XXY: An unusual presentation.

Ovotesticular disorder of sex development (OT-DSD) is a rare disorder of sexual differentiation characterized by the presence of both ovarian and testicular tissues in the same individual. It's incidence ranges from 3% to 10% of all disorder of DSD's, and the most common presentation is 46, XX followed by 46, XX/46, XY mosaicism and 46, XY. Klinefelter syndrome (KS) mosaicism 46, XX/47, XXY is extremely rare, and its association with the ovotesticular disorder is even rarer. We report an unusual case of 16-year-old with male habitus who presented with complains of cyclic hematuria. On examination, he had bilateral gynecomastia, unilateral left cryptorchidism, absent facial hair, sparse axillary hair growth, and pubic hair distribution of feminine type. The right testis was of normal size located normally in hemiscrotum and was confirmed by radio imaging. Ultrasonography and magnetic resonance imaging revealed a cystic area behind posterior half of urinary bladder. Chromosomal analysis revealed 46, XX/47, XXY mosaicism of female karyotype and KS. Histopathological report of this left side excised specimen confirmed the structures to be ovary, uterus, and fallopian tube, thus confirming our diagnosis of the lateral ovotesticular disorder. Meticulous workup combined interdisciplinary approach will lead to early diagnosis and resolve timely sex reassignment issues and also prevent consequences arising due to gonadal insufficiency.

A Spectrum of Urological Emergency Reported at a Tertiary Care Teaching Hospital: An Experience.

INTRODUCTION: A substantial number of urology admissions constitute of emergency cases and sizeable proportion are urology emergency referral cases. There have been few studies conducted on this aspect but there lie geographical variations in the presentations of urological emergencies. Hence, this study was conducted to analyse various urological emergency presentations and their interventions. OBJECTIVE: To estimate the proportion of urological emergencies and analyse the different type of urological emergencies with the required management. MATERIALS AND METHODS: A hospital based observational descriptive study was undertaken in our institution over a period of one year. RESULTS: A total of 11,139 cases were admitted in the urology department; of which a significant percentage (21.05%) was from emergency room. Majority of cross references came from the Department of Medicine (22.59 %). Renal colic (24.2%) happened to be the most common presentation in emergency room followed by acute urinary retention (14.7%). Among referred cases, hematuria was the leading presentation with 17.75% followed by traumatic catheterization (11.97%). Most common urological intervention in referred cases was supra pubic catheterization (27.20%) while it was percutaneous nephrostomy (32.78%) in directly admitted cases. CONCLUSION: Urological emergencies constitute a significant proportion of total urology admissions (27.18%). The most common non-traumatic injury was renal colic whereas traumatic was traumatic catheterization in our study. Most common surgical intervention in direct admitted emergency cases was percutaneous nephrostomy whereassuprapubic catheterization in within hospital emergency referral cases.